OPHTE# IT_ -a~ Harnett County Department of Public Health
PERMIT Operation Permit 2 21 5 0
New Installation Septic Tank Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATIO : \rl +1-1- L1yc N,
Name: (owner) AN Do-) "o MC-5 SUBDIVISION ` ,s"llYc> 1AY--Q.CZ-\ 14 (0 LOT #
System Installer: N je.,. J Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms ?I_
Type of Water Supply: ❑ Community X Public ❑ Well Distance from well 100 feet
System Type: a Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and
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PERMIT CONDITIONS:
I. Performance:
II. Monitoring:
III. Maintenance:
IV. Operation:
V. Other:
System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting,
and all conditions of the
1-34,
Permit and Construction Authorization.
❑
D-Box
❑ Pump ❑ Al
arm ❑
H20Line ❑
PWR Line
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ❑
Conventional
Other `z. s.c'w Septic Tank: t o®o
gallons Pum
Tank:
ll
Subsurface
Drainage Field
No. of
ditches
exact length width of
f
h
'8 O
p
ga
ons
depth of
French Drain Required:,
o
eac
ditch
feet ditches 3
.,Cjnear feet
feet ditches inches
Authorized State Agent yp 1
l
Date ~